1994, 10-07 Permit App: 94009930 ReroofAPPLICATION INFORMATION
gL
q'.? 30
SITE ADRSS ) , VV
1t D -Q
Parcel number
Legal de ripon
'01 "
In spectordistrict,
Property: size::
Right:of. way width::
Water district
OWNER�\
PS ‘'V\N.\\`R'N
Phone
Address
APPLICANT
to\h) `-VN
City, state
W
Zip
Address
City, state
3
9 �-b5
Zip
CONTACT
Phone
PERMIT USE
Building
o-o.[i - l 7) 0
New _ Change of use_
Add Remodel
Building height
Stories
Contractor
Dimensions
Total square footage
License
Main floor
Unfinished basement
Address
Second floor
Finished basement
Architect/Engineer
Garage
Decks, etc.
Value
Manufactured Home
Sign
Width:
Length:
Square footage
Height
Year:
Make:
Contractor
Contractor
License
License
Address
Address
City, state, zip
City, state, zip
Relocation
Fire Safety
Previous address
Fire Sprinkler Tent _
Paint booth _ Fire Alarm Fireworks display _
VALUE
Contractor
Contractor
License
License
Address
Address
City, state, zip
City, state, zip
Fuel Storage Tanks
(Circle one) Above -ground Underground
Swimming Pool
Contents
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Contractor
License
License
Address
Address
City, state, zip
City, state, zip
CCN CO'ffREGSTRATION NU BER
'.,'. --..,,-',• •- ,-..:.;•:..1.-'•'.'-.—..--::- ',
',141etkpiPtist 'RC)0F4,
N 4018 P,81 -i ST
SP 014. • :- 9920
AL 0 0
DEPARTMENT OF LABOR AND INDUSTRIES
- - - - -- -
SIGNATURE
ISSUED BY
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